CLEVELAND, Ohio -- Hundreds of readers and commenters, including former and current employees of nursing homes, have responded to the first installments of The Plain Dealer's investigation, "A Critical Choice,'' about the quality of care in many of Ohio's care facilities.

Workers stressed how chronic understaffing made their jobs even more stressful.

"Almost always, we had to work short-handed, handling anywhere from 15 to 20 people at any given time,'' former nurse's aide Lolly wrote. "It is impossible to give proper care to that many people, answer the call lights and be everywhere at the same time.''

Anne, who worked as a nurse's aide, said in an email: "You have to have a tremendous amount of patience. It is beyond hard work. But you have to realize that these [nursing home employees] are very special people."

To share your stories: Use the confidential form at the bottom of this post, or email the authors at jcaniglia@plaind.com or jcorrigan@plaind.com

A Licensed Practical Nurse who works at a nursing home in the region said understaffing is the biggest issue that prevents her from doing her job. She and other staffers run from crisis to crisis, she said.

"That's what nursing homes are about,'' she said in an interview Friday, declining to be identified because she works in the industry.

As The Plain Dealer continues its series next week and in the coming months, we would like to hear from other employees and others who have had experiences with care facilities. We also would like to hear other personal accounts from loved ones.

In addition, we ask that you share with us your documentation such as complaints, letters from regulators, and other records about successes or lapses.

Families of many nursing home residents already have told us how their loved ones were treated. Some said they witnessed neglect and contempt; others saw care and empathy.

The responses noted many of the main themes of the stories: chronic understaffing at nursing homes, the need for residents to have advocates, the best ways to find quality nursing homes, and the government's rating system.

TruthNotPretty, a screen name used by one of several commenters on cleveland.com, talked about a nursing home experience.

"When my mother needed a nursing facility we chose a location that several people we knew said treated their family member well a year or two earlier,'' the commenter said. "What we experienced was constant understaffing due to people calling off sick, aides that would respond to an electronic call by coming in the room, turning off the alarm indicating they took care of the issue - but leaving without doing anything.

"We witnessed this ourselves several times a week and had to chase them down 45 minutes after they turned off the signal. Imagine what happened when we were not there to chase them down.''

Another commenter, David44149, asked, "Is it any wonder why people are scared to move into Ohio nursing homes? I am going to stay home until I can no longer help myself, and then hopefully die before getting shoved into one of these places."

Commenter Nicki agreed: "It is so sad how the system is. I wish all nursing homes had higher standards and we could get rid of these fly-by-night schools that charge a fortune but don't truly prepare nurses for their jobs."

Here's what other readers had to say about other issues:

On finding a nursing home and dealing with staff: Cloverline, a commenter, posted a note about the experience of finding a facility.

"I have been involved in the decision to place loved ones in nursing homes,'' the commenter said. "It was horrible to be part of the process, and much more so for the persons placed in one. I have told my family that if I need to be placed in a nursing home to wait for death, I hope they will just kill me dead on the spot.''

"When my mother-in-law suddenly needed a nursing home, we supplemented our research by talking to several local clergy members. They see nursing homes regularly and without formal tours, and they notice things that are not in the website reports. The place that had the best clergy reports turned out to be the one we chose, and it was a good decision.''

Gainesville Steve said vigilance continues after choosing a facility. "Visit as often as you can and be very engaged with the staff. Learn their names, their schedules, ask questions, show interest in how they care for your loved one. Be polite but firm. If your loved one is waiting too long for a bath or medication, be assertive. Go up to the front desk and ask for someone to come to your loved one's room.

"Ask to be notified at home anytime there is an incident: a fall, confrontation with staff or other residents, etc. Thank the staff every chance you get. It is a difficult and thankless job, and they will notice.''

On quality nursing homes: In emails to reporters, readers submitted a number of quality nursing homes in Northeast Ohio. They praised Wickliffe Country Place in Wickliffe, Holly Hill Nursing Home in Newbury, Gateway in Euclid, Altenheim in Strongsville, and O'Neill Healthcare in Bay Village.

"During my visits I was able to observe quite a lot,'' a reader emailed about the Bay facility. "The care not only to my husband but to all residents on Unit 2 or in the Dining Room, was exceptional. Yes, there were things or events that happened, but they were always handled with dignity and care for each resident.''

On the government's rating system: The Centers for Medicare and Medicaid uses Nursing Home Compare, a system that rates nursing homes in America. The system is based on inspections, quality measures and staffing, and it uses on a scale of one to five, with one being the lowest. There were many critics of the system.

"The star system is a joke,'' Nicki said in a comment to cleveland.com. "You can have five stars and still be bad. Your staffing can be low, and your stars can still be high. Are you serious? Sad.''

Another commenter also brought up the rating system.

"Awareness is the first step in change,'' Truthseeker said. "How do we improve quality and keep costs down? Are the best practices from the five-star homes being shared? Why would anyone choose to go to a one-star home?''